Journal of the American College of Surgeons
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Comparative Study
Increasing reporting of adverse events to improve the educational value of the morbidity and mortality conference.
The aim of this study was to investigate the impact of a validated complication proforma on surgical Morbidity and Mortality (M&M) conference reporting. ⋯ We demonstrated that prospective standardized incident recording provides significantly more accurate assessment of M&M data compared with current reporting methods. This increased accuracy should favorably affect surgical performance indicators and casemix funding.
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Many published accounts of clinical trials report no differences between the treatment arms, while being underpowered to find differences. This study determined how the authors of these reports interpreted their findings. ⋯ Negative findings in underpowered trials were often interpreted as showing the equivalence of the treatment arms with no discussion of the issue of being underpowered. This may lead clinicians to accept new treatments that have not been validated.
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Appendiceal perforation (AP) is a marker of health care disparities. We propose that racial disparities in children, as measured by AP, may change according to the type of hospital in which a child receives care. ⋯ These results underscore differential patterns of AP at the hospital level and deserve immediate attention because they may reflect far larger disparities in access and quality of care for children in California. Future interventions aimed at eliminating racial disparities in children must account for racial differences in access to timely diagnostic and surgical intervention for rapidly progressive and preventable clinical conditions such as AP.
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Comparative Study
Resident participation in index laparoscopic general surgical cases: impact of the learning environment on surgical outcomes.
The NSQIP database enables measurement of postoperative outcomes across a spectrum of practice settings. This allows for observations about potential effects of resident participation in surgical care during training. ⋯ Resident participation increases operative times for laparoscopic surgery considerably. Morbidity is statistically higher with resident participation but differences are unlikely to be clinically significant. Resident participation is a surrogate for the learning environment. These findings provide impetus for additional development of training techniques that occur outside the operating room.